A new state law requires insurers to cover prescribed drugs immediately while step-therapy appeals are pending—and it could raise your group health premiums.
Most auto service owners don't realize that a provision buried in New Hampshire's HB1638 is about to change how their group health insurance works—and what they'll pay for it.
The law creates what's called a "bypass mechanism" for step-therapy protocols. That's insurance jargon for a process that, until now, has worked like this: your employee's doctor prescribes a medication. The insurer says, "Not yet—try this cheaper drug first." The doctor and patient appeal. While that appeal sits in limbo, the employee either waits or pays out of pocket.
HB1638 changes that. Starting 90 days after the bill's passage, insurers must cover the drug the doctor prescribed while the appeal is still pending. If the insurer doesn't respond to an override request within a set timeframe, the request auto-approves, and the drug is covered anyway.
If your auto service operates in New Hampshire and offers a group health plan—whether you self-insure or buy a fully-insured plan from a carrier—this applies to you. The requirement is codified in RSA 420-J:32, VI (Bill Section 1, pages 5–6).
Self-insured employers feel the cost directly: claims come out of your plan's reserves. Fully-insured shop owners don't see individual claims, but carriers pass increased costs forward through premium adjustments at renewal.
The practical effect is straightforward: more drugs will be covered immediately, rather than delayed. That increases claim volume and cost. For a small business with 10 to 50 employees, this could mean higher premiums at your next renewal cycle.
The trade-off, from a policy perspective, is patient access: employees get prescribed medications faster, which can mean fewer missed workdays and better health outcomes. But the cost is real, and it flows into your group plan's pricing.
The provision becomes effective 90 days after HB1638's passage. If you haven't already reviewed your group plan documents or spoken with your broker about how this will affect your renewal, now is the time.
Questions to ask your insurance broker or carrier:
The law is designed to ensure employees get medically necessary drugs without unnecessary delays. The cost of that benefit—like all insurance costs—ultimately lands on employers. Understanding the change now gives you time to plan.
For a free, detailed guide to how HB1638 affects New Hampshire auto service businesses, contact your state trade association or local business insurance advisor.